Category: Leadership

As a rule, Keep your mouth shut works almost everywhere. Most things get worse when we speak.

However, silence can cause trouble, too. Even a pause can be deadly:

Who do you love most: me, or my sister? 

Mom, was I a surprise pregnancy?

If we want safety, silence offers the best protection. It makes sense to hide and keep really quiet, when danger prowls – but not for leaders.

Doctors must lead. And leaders need to speak; precisely when everyone else is sliding down in their seats around the table.

Leaders must say something, even when there is nothing perfect to offer. Silence does nothing for a team. But we have to be careful, too: empty platitudes can come across like ‘Get Well’ cards at a funeral.

Medical Politics Thriller

If this were a spy thriller, Ontario sits at the point in the story when a bomb has just been found under the parliament buildings.

Helicopters circle. People run around screaming, and a sweating bomb tech, in safety gear, extends a shaking set of snips towards a jumble of wires.

Will he cut the blue wire…or the red one?

If you Google crisis + leadership, millions of results pop up like:

• How a Good Leader Reacts to a Crisis
• Leadership in Crisis – How to be a Leaders
• 7 Tips on How to Be a Great Leader During a Crisis
• 11 Tips to Leading During a Time of Crisis

 These offer great advice. But doctors need something a bit different.

In Ontario, leaders have stepped forward from all sides: within the establishment, without, and in between. For all leaders, here are 7 tips:

Crisis Management for Doctors

1) Be cool – Lighting our hair on fire comes naturally for some. The heat and smoke releases energy and feels good, I suppose. Resist the urge, no matter how much better it makes you feel.

Everyone who looks to your reaction feels much worse when you lose control, even with an audience of one.

2) Avoid the simplistic – Us against them wins on a football field, but not with large groups. Black and white works well until kindergarten.

Oversimplifying complexity might seem to add sanity for a moment, but it never leads us out of a crisis.

3) Keep making friends – Fights during Thanksgiving dinner often leave deep, irreparable scars. Remember whom you are fighting with.

You may need to see them for your heart attack next week.

4) Forgive more – People make dozens of mistakes every hour, at their best. Under duress, we make many more. Itemized lists of all the ways other people messed up, acted poorly, or otherwise disappointed us rule out reconciliation.

Do not assume maleficence, when ignorance explains behaviour well enough.

5) Plan for the future – Force yourself to imagine life after this crisis has past. Even if things do not work out in your favour, this crisis, too, shall pass.

Your response will shape your experience of life afterwards.

6) Stop and think – Surviving the next minute blocks out all other thought in a crisis. We need more time to reflect, at the exact moment when there isn’t time to breath.

Stop. Think. Take 10 minutes to read. Pseudo-dementia comes from cognitive overload.

7) Remain positive – I think it was Dee Hock, founder and CEO of Visa, who said something like, “The times are too tough, and the outlook too dire, for negativity.”

We need hope the most, when hope seems most unreasonable.

Crisis and Silence

Trauma and crises are not all bad. Birth is traumatic, violent even. Full lives have very few dull moments. Dreams of peace and quiet come true only for the most heavily sedated, on locked wards.

The excitement in Ontario will pass, eventually. We will go back to working together, sharing patients, and finding ways to work with others to improve our healthcare system. But during a crisis, many people find it safer to clam up and keep silent.

We need people to offer reasons for hope, no matter which direction this turns. Silence is not an option in crisis management.

Photo credit: The Hurt Locker

I envy prophets. They just stand on a street corner and tell us when the world will end.

Their message fits on a piece of cardboard. They have low overhead and never have to compromise.

Anyone can be a prophet. You just need a message and courage to share it.

But effective prophets have short careers on the street. People notice them.

Once enough people recognize them, prophets get invited to apply for hospital leadership, or to run for election. After moving from the street corner into an office, prophets find that life gets complicated.

Simple, prophetic messages raise complex questions. For example: How do we prepare for the END? How should healthcare be organized?

Prophets find leadership filled with complexity, ambiguity, and tradeoffs.

Only dictators experience leadership without compromise.

Recently, a Member of Parliament described his dissenting opinion on a major decision to me. The majority often voted against his positions.

I asked how he survives, since Members usually do not get to write dissenting opinions. I wondered: How does he decide to stay and risk being seen to support bad decisions?

“If I leave, then no one will speak to these issues,” he said.

Democracy is Messy

A representative, constitutional democracy must hear all views, and the majority must follow a constitution. It prevents mob rule by majority. The constitution sets rules that a majority cannot break.

What happens when a democracy must make an either/or decision like: Do we go to war?

The country finds out what everyone thinks, not just the majority, a special interest, or elite group. Leaders seek counsel from experts on the issue. The decision must fall within the ambit of the constitution (for example, slavery is not open for discussion).

Then leaders make a decision.

Once the country decides to go to war, it goes together.

Minority Voice & Influence

Minority leaders face two options:

1) Be true to their message and remain a fringe voice.

2) Try to compromise their message to gain access to where groups makes final decisions.

This struggle has played out in every country, and every Boardroom, since humans started working together.

It forces people in leadership to do 3 things:

1) Know what they believe, what they will never compromise.

2) Get comfortable with ambiguity and complexity.

3) Remain flexible, and humble enough to change their mind.

Number 1) sets limits and protects leaders from becoming a sycophant to power. Number 2) develops wisdom and diplomacy. Number 3) keeps leaders grounded, human.

Every decision, no matter how minor, forces prophets-cum-leaders through these 3 steps.

Have I crossed the line?

Is this wise?

Am I rigid and blind?

Prophets in Suits

Prophets have life easy. They live in a black and white reality and hope that people hear their message.

Sycophantic leaders have life easy, too. They just identify popular opinion and go with the flow.

But every organization needs courageous leaders with vision. All leaders are prophets in a sense. They are prophets in suits. Leaders without vision should not be in leadership.

We need courageous people, inside every organization, to speak with courage, and to lead with conviction, wisdom, and humility.

We need prophets in suits with courage to stay, especially when their message is not heard.

Sometimes you will land with the majority, at other times not. All people can do is trust that you acted with integrity.

Regardless of the issue, no one wins if people with minority opinions leave every time they sit on the short side of a vote.

 

 

How do they get birds out of Costco?

My kids love to see birds fly around the warehouse. Costco must hate it.

No doubt, birds in Costco break a list of public health rules.

There are three ways to get birds out of a warehouse: kill them, trap them, or encourage behavioural change (see more here and here).

The first two options offer military solutions: dispatch or take custody. Neither approach works well with humans, outside of war or totalitarian control. Does government know this?

Behavioural Change

All leaders work to influence behavioural change. Everything else that they do is wasted effort or should be done by someone else.

Leaders work to change behaviour, not to write policy manuals, discipline protocols, or to file reports to regulators.

Leaders must understand behavioural change, or they are not leaders.

People in positions of leadership often do not understand what they are supposed to do and have no idea how to get it done.

Impossible to Manage

Humans find ways to break rules and turn the most well-intentioned incentives into perverse behaviours.

We can follow the letter of the law but deny its spirit.

We cannot be forced to act, any more than we can think or believe as instructed.

Humans are frustratingly free and complex.

Only people with damaged brains think, believe, and act exactly as told.

Given people’s tendency to make up their own minds, how can leaders change behaviour?

Not Rocket Science

It’s actually quite simple, if we think like a pre-teen. How does an older sister get her brother to play along with something he does not want to do?

She could offer a bribe, but that often ends poorly.

Her brother is young, not stupid. The bribe becomes a quest. He will anchor on the bribe and negotiate to the death. His sister will sacrifice more than she hoped for, or abandon the task.

Every older sister figures out how to manger her younger brother shortly after she learns how to skip rope. If we asked, she would tell us:

First, you need to catch your brother’s interest. Show him something shiny or dangerous.

Then, build on the excitement and invite him into relationship. Hint at the opportunity for more, bigger, shiny things: This sets the hook.

Invite him on a quest. Build a description of the destination together, in vivid detail. Let him shape what the destination looks like to him.

Set him loose with a title and a mission to accomplish.

Then, work together, offering encouragement and praise until the job is done. Remind him of how fun this quest was the next time you need him to do something.

Doesn’t government know this? They find doctors impossible to manage because they forget the basics. They should try to the following:

Catch doctors’ interest: show them an opportunity to fix a patient care problem that frustrates doctors, not accountants or Ministers of Finance.

Build on the interest by fostering relationship. Hint at the opportunity to solve bigger problems together.

Invite doctors on a quest. Let doctors shape and define the destination together with government.

Empower doctors to tackle the quest. Encourage them. Give them the materials they need to get the job done.

Work alongside doctors until the job is finished.

Offer praise liberally. Hint at the next exciting job to tackle.

Is this too simplistic? Probably, but that’s the point. It’s so simple that doctors can see what’s going on. Politicians should want doctors to see through what government is doing and get excited about it.

Politicians need to build trust with dozens of small projects before trying to change all of primary care at once, with something like Bill 210 (see Will Medicine Survive in Ontario).

Entice Change

Birds fly out of Costco when someone attracts the birds to leave. The only other way is to trap or kill them.

Government, regulators, and system managers need to take a new approach to ‘managing’ physicians. Regulatory and legislative traps do not work. System leaders cannot manage doctors like the military. They must entice docs to change. All other options kill doctors’ professional spirit.

photo credit: pbs.org